Rodney Smith, St Vincent’s Hospital: Creating Team Based Models of Care at St Vincent’s Hospital...

Whole of Hospital Approach to NEAT

Team Based Hospital Plan 27 Feb 2014 Rodney Smith

Patient Flow Manager

Purpose

Who are we?

Context – NEAT

Bed management project

Achievements

Ongoing challenges

Day/Month/Year Footnote to go here


Who are we?

• A Catholic mission and values based organisation founded over 150 years ago by the Sister’s of Charity, now under the stewardship of Mary Aikenhead Ministries, funded by NSW Ministry of Health to provide health care services

• 253 acute inpt beds, 41 pall care beds and 31 rehab beds. 27 mental health beds. Outpt clinics including heart and lung, hospital in the home, oncology, HIV/immunology and renal ambulatory care

• 10 bed homeless health service and 10 bed and outpt drug and alcohol service


Who are we?

• Situated in the inner city suburb of Darlinghurst with a diverse mix of socio economic demographics

• D&A

• Mental health

• Homelessness

• Aged

• Middle to upper socio-economic

• Major trauma centre with quaternary services: Heart and lung transplant and bone marrow transplant services

• 4 Programs – Acute, Heart/Lung, Geriatric/ambulatory medicine, Cancer and immunology and Mental health each with a Director (medical) and manager (nursing)


Who are we?

• Mission and Values

• 150 yrs worth that provide a framework for what we do and what we want to achieve

• Compassion, Justice, Integrity, Excellence

• Ingrained into the culture

• Used a driver and basis for change


NEAT is here!

• NSW MoH NEAT targets

• 2013 – 71%

• 2014 – 83%

• 2015 – 90%

If we improve our systems and processes we will improve patient care and the target will be met.

The driver must be improving patient care and not the target


Our Journey – the context

• Stranded Sam – LOS>21 days • ePJB

• RED project

• NEAT ED model of care project

• Lean Healthcare (2012)

• Lean principles

• Bed Management Project


Bed Management Project

• Recognition that in order for NEAT to be achieved we needed to change our bed management practices in parallel with other initiatives/projects

• Until Nov 2012 the bed manager was fixed and took responsibility for placing pts


Background

“Where are we now study” study showed a significant delay in bed request/allocation/ready

Median time 7:18 hrs

Mean time 10:00 hrs

Issues pertain to back of hospital, patient flow and bed management practices across the board

Direct link between bed management and flow out of ED


The Team

Executive Sponsor – Director of Operations

Project Lead/Manager – NM Patient Flow

Project Team:

- Bed Manager

- NM Surgery and Renal

- Surgical NUM

- NM Nursing Workforce (rep AHNM)

- NUM ED

- PM

- NUM Rehab

Navigating Project Management 101

• Project charter –

• Goal

• Deliverables

• Methodology

• Interdependence

• Governance

• Scope

• Start and finish

• Team and sponsor

• Evaluation

• Communication

• Risk log



Diagnostics/Current state

• VSM current state

• 250 issues

• Process map AHNM bed management

• 86 issues

• Data analysis – NEAT 47%

• NEAT staff questionnaire

Current state



Issues Identified

• Multiple unnecessary communication (NVA)

• Lack of processes/business rules regarding handover and transfer of pts from ED

• Confusion regarding escalation and response

• Inability to contact people (phones not answered)

• Inconsistency in bed allocation process in and out of hrs

• Variable experience of team leaders and no clearly defined expectations

• Lack of a sense of urgency and ownership (hospital wide)

• Lack of visibility and knowledge of priorities (ED, Elective, Clinics)

• Organisational structure/governance

Solutions – Process change

• 3 x a day bed management round


Solutions - Communication

• All NUM’s/ward areas have mobile phones for patient flow (Quick win)

• Bed manager mobile and AHNM mobile diverted from the one land line so there is 24/7 access (Quick win)

• Business rules for each access point (ED/Elective/3rd door) were created/updated and placed on a patient flow tab on the clinical web page – accessible to all

• iPAD (Bed manager and AHNM) – EDIS, booked admissions, IHT list (Quick win)

• Pull rather than push – ETA

• New escalation process with roles and responsibilities

• Bed meeting short and sharp – with clear structure, expectations and outcome


Solutions - Transparency

• Responsibility and transparency around demand/capacity

• NUM’s and Program Managers receive elective admission list day before

• Bed Manager has an iPAD with access to EDIS

• ePJB and WD have the ED demand at the bottom of the ward screen in a different colour


TAKT time for each ward

27/2/2014

Solutions - Pull

• Pull rather than Push!

• Once demand is transparent and priorities are set the NUM’s/team leaders can pull patients into the ward beds when ready

• Allocation occurs on EDIS and WebDelacy

• Tracks time of allocation to transfer

• Stops constant calls from ED – “is the bed ready yet?” chant! Helps eliminate horizontal violence


Solutions - Leadership

• Patient flow manager, Bed manager, AHNM provide leadership and mentorship to NUM’s and team leaders during rounds

• Provide a sense of urgency and reasons for this ie: good patient care

• Conversations around needs of patients and handovers

• Set expectations of team leader and NUM roles in patient flow – know what questions to ask to plant the seed (can the pt. sit out to clear the bed)

• Visibility and relationships

• Creating the culture



Implementation

• Communication strategy

• Email, posters, presentations (committees), education (wards, managers)

• DO IT!

• 2 weeks before the NEAT ED models of care started (Nov 2012)

• Commitment – patient flow manager attends first round EVERY day

Evaluation


• Presentation of results to the wards after 6 months

Wards


Overall


Overall NEAT improvement


Keys to success

• Executive engagement and commitment

• Communication strategies

• Engaging the right people

• Good leadership from everyone

• Staying within the scope and always going back to the charter objectives


Where to from here?

• Further evaluation with staff questionnaires

• Improve escalation processes

• Recent acute patient flow workshop to evaluate and continue the process

• Maintain the momentum



Questions

Rodney Smith, St Vincent’s Hospital: Creating Team Based Models of Care at St Vincent’s Hospital...

Health & Medicine

Transcript of Rodney Smith, St Vincent’s Hospital: Creating Team Based Models of Care at St Vincent’s Hospital...